Health Minister Eric Hoskins says he believes that national universal pharmacare is "inevitable" and Premier Kathleen Wynne will be its Tommy Douglas.
Ontario's OHIP+ program, which will provide free coverage of the 4,400-plus prescription medications in the Ontario Drug Benefit Formulary for all Ontarians under age 25, launches on Jan. 1.
Hoskins calls OHIP+ "the biggest expansion of medicare since medicare was created" and he deliberately places it on the arc of Canadian medical history as it bends toward a national universal pharmacare program.
"I believe it's inevitable. I believe that it is coming," he told QP Briefing in an interview. "We're looking at the how, as opposed to the if."
Hoskins said OHIP+ first took root when he was hosting a federal-provincial-territorial health ministers meeting in October 2016 and brought forward a proposal to provide medicine to children, similar to OHIP+, on a national scale.
The idea was that it could be "a big leap forward" toward a national universal pharmacare program, he said. There was a lot of interest in the idea around the table.
The next step was a conversation with Wynne, he said.
"Early this year, we were talking about the budget and had a conversation about pharmacare, just for Ontario," Hoskins said. "So we talked about children, and talked about extending that ... to 24 and younger, and why that might be important as well, and she said, 'Let's do it.' So here we are."
The Ontario government included the OHIP+ plan in its April budget, at a cost of $450 million a year.
Wynne advocated for pharmacare at the Council of the Federation meeting of premiers last summer and came away with a directive for health ministers to continue and deepen their work with the federal government on developing plans, he said.
Then, the country's health ministers met in October and committed to developing what a national pharmacare plan might look like, Hoskins said.
National advocacy is one part of Ontario's plan — the other is determining what Ontario itself can do.
In a recent interview with the CBC, Wynne phrased it this way: "I'm going to continue to push at the national level for a national pharmacare plan. If that doesn't happen, then we have to have a serious conversation about how we move forward."
Hoskins interpreted the quote in two parts — the first being the national advocacy he's described.
"The second part I read in the premier's comment is if that's not immediately successful, we need to look at Ontario on its own, providing leadership, or demonstrating leadership, like we are with OHIP+, that it can be done and should be done, and it's necessary, particularly when one out of 10 families doesn't purchase their medicine because they can't afford it," he said.
The Wynne government has been in a similar position before, pushing for national change on an issue while simultaneously creating a made-in-Ontario proposal to address it.
In the last provincial election, the Ontario Liberals campaigned for the Ontario Retirement Pension Plan and proceeded to create it — legislation, bureaucracy and all — while continuing to advocate for an expansion of the Canada Pension Plan. When the country came to an agreement on CPP enhancement, Ontario scrapped the ORPP and Wynne took credit for pushing the national discussion forward.
Will we see an ORPP repeat in universal pharmacare?
"Maybe," Hoskins said. "This is like the pensions; it would be better if it was uniform across the country and I think that's everybody's goal, as well."
However, it's not so much that Ontario would go it alone on pharmacare, more that the province will prove that it can be done, he qualified. "We'll provide that leadership."
"It's more of a Tommy Douglas moment, I would say, Kathleen Wynne is channeling Tommy Douglas — if you can believe that — if you look at it that way, where he provided that provincial leadership for medicare, and look where we are today."
Douglas, of course, is known as the father of medicare for bringing universal medical insurance to Saskatchewan, before the model was adopted nationally.
"Access to medicines needs to be seen as part of the medical system, just like access to the ER or home care, or your family doctor," Hoskins said. "That's how it was always imagined, right back in the '60s, that pharmacare would be part of that universal health-care system."
The NDP is also hoping to claim the mother-of-pharmacare mantle, campaigning on a promise to create "Ontario’s first universal pharmacare program," which would provide coverage of 125 essential medicines to Ontarians of all ages.
"Just as Tommy Douglas started Medicare in Saskatchewan with hospital insurance and it expanded to include all Canadians, New Democrats will build universal Pharmacare in Ontario and work to expand it to achieve universal and comprehensive national Pharmacare for all Canadians," the NDP says in its pharmacare plan.
For their part, the Progressive Conservatives have pledged to keep the Liberal government's OHIP+ plan in place, should they win the next election.
According to Hoskins, the cost of universal pharmacare for Ontarians of all ages would be many multiples of the $450 million a year of OHIP+ and that would depend on whether the province would expand the model Ontario has for seniors — where there's a co-payment and deductible — or the model it will have as of January 1 for youth — completely free.
"But, it needs to be seen in the context of a health-care budget that's $52 to $53 billion a year," Hoskins said. "Those are the things that we're looking at: how to expand it, where to expand it, and what the cost of expansion would be."
Asked what this means for the June 2018 election, Hoskins went with a grin and said, "I don't know, we'll have to wait and see."
"I know that the work is not done."